Hi Eva
I am not medically trained so I will try to answer your question from the knowledge I have gleaned from running this site -
but on the whole I think your GPs advice is the right one to follow.
Please note this is only my opinion only and I urge you to consult a qualified medical practitioner before taking anything.
A great site for advice about what is safe for to injest when breastfeeding was suggested by Moe below - it is :
www.e-lactancia.org/ingles/inicio.aspThis site lists many Pharmaceutical Drugs and other products such as vitimins and herbs and their sutability and safety when breastfeeding.
This is a question (breastfeeding and medication) that comes up time and time again and the answer is that the first advice that you will get from everyone is that it is best not to take anything when breast feeding.
There is no ‘recommended antidepressants for breastfeeding’
This is why you are getting mixed information as the pharmacist will be trained to advice against taking any antidepressants at all and his knowledge will be based on the drug companies general warnings and not your individual circumstanses.
However their are some Anti Ds which have been taken for many years ( over 30 in some cases) by women who are breastfeeding and with no apparent ill effects on your baby - I will get to these later.
Also your GP - locum or not - is more qualified to judge what you can and can not take when breastfeeding and will have taken all you circumstances into consideration when prescribing the medication. Sometimes GPs do prescribe nursing mothers the newer Anti Ds as they will have weighed up any risks and decided this would be the best drug for you.
I am confused as to why having had a prescription from a qualified doctor you are then getting an opinion from your pharmacist.
Do you not trust the doctor you saw and are asking the pharmacist when you go to get your prescription?
(The pharmacist who not having access to your personal medical history and not having done many years medical training, to avoid litigation, can only give you one answer - that no Ant D medication is safe to use while breastfeeding).
The doctor does have access to your medical notes, more training and more up to date information on drugs and breastfeeding and I am sure he would not prescribe anything that could be dangerous.
Or is the Pharmacist offering this advice unasked?
if this is so I should tell him that you have been prescribed these Anti Ds in the full knowledge that you are breast feeding and the GP has taken all your medical history into consideration and assessed the risks and in his qualified opinion it is perfectly safe to take the medication he has prescribed.
The doctor really is the person you should be listening to here!
However having said this I am also going to give you more conflicting opinion as I would agree that all the stuff I have read has said that St Johns Wort is not safe when pregnant or breastfeeding!
So I contacted a practicing herbalist I know who has a degree in Botany and she said that while she could not recommend it, it would be alright to take on the advice of a qualified GP as she/he would have weighed up the very small risk i.e. the small amount going into the breast milk with the benefits to you - so again I would listen to your doctors advice on this also.
However in a comparison of St Johns Wort and Sertraline St Johns Wort was not found to be not a very effective in treating major depressive disorder but then neither was Steraline!! See
www.ukmi.nhs.uk/NewMaterial/html/docs/20050202.pdfAs to sertraline
www.nlm.nih.gov/medlineplus/druginfo/medmaster/a697048.htmlwww.rxlist.com/cgi/generic/sertral.htmwww.parkinsons-information-exchange-network-online.com/drugdb/121.htmlThis is a Selective Serotonin Reuptake Inhibitor (SSRI) commonly called Zoloft . Other SSRIs are Escitalopram, paroxetine , fluoxetine
www.prodigy.nhs.uk/ClinicalGuidance/ReleasedGuidance/webBrowser/pils/PL199.htm Which makes it quite a new drug and in my opinion this means it will not have had years of being used by breastfeeding mothers for anyone to know it is totally safe. But it is prescribed with caution to breast feeding mothers.
The current advice to doctors seems to be ‘There is limited information on use of the selective serotonin reuptake inhibitors (SSRIs) in lactation,
including any potential long-term adverse effects.
SSRIs should be used with caution. Sertraline or paroxetine are preferred to fluoxetine.’ The British National formulary says : sertraline of which they say 'Present in milk but not known to be harmful in short-term use'
and Paroxetine 'Present in milk but amount too small to be harmful'
www.ukmi.nhs.uk/NewMaterial/html/docs/19080202.pdfSSRI antidepressants are used to treat depression and some other conditions. They take 2-4 weeks to work fully. Treatment usually lasts six months or more. Side-effects may occur, but are often minor. At the end of course of treatment, you should gradually reduce the dose before stopping completely.
However I do know what others have been prescribed over the years and the Anti D’s that doctors will prescribe more often for for breastfeeding mothers are the older anti depressants like Tricyclic antidepressants.
The advice on this is
‘Tricyclic antidepressants (TCAs) should be used with caution in breastfeeding women. Infants should be monitored for
sedation or irritability.1 Doxepin is contraindicated in lactation, as its active metabolite may accumulate in the infant, and
There has been a case reported of respiratory depression and sedation in one infant’
However Older type anti depressants that are prescribed by some for women who are breast feeding are : CLomipramine - HCL ( Anafranil)
Amitriptyline ( Amitrol, Domiicl, Elavil, Endep, Lentizol)
This is related to the tricyclic antidepressant drugs but apparently more effective.
TCAs are older drugs but very often prescribed for PNI because it can be effective as and current research suggest that TCA is not actively secreted into breast milk
It is used for depression with anxiety
As well as not passing into breast milk the other reasons some of the older anti depressants are believed to be safe enough to prescribe to breastfeeding women is because they have been around so long ( I was prescribed a short course of tricyclic antidepressant in 1970!) that they know them to have little history of causing any problems in breast fed babies.
If they caused significant problems I think this would be well known by now – hundreds of women have taken them when pregnant and breastfeeding.
National Medicines Information Centre report ‘DRUGS IN LACTATION’ concludes.
In summary, TCAs (except doxepin) and SSRIs are considered to be compatible with breastfeeding, but careful
monitoring of the infant is essential when any antidepressant is used..
So in conclusion it seems to me as a lay person, that while many doctors play safe and prescribe the tried and tested older Anti Ds to breastfeeding mothers your doctor was quite right to prescribe Sertraline and must have taken into consideration your unique circumstances and medical history to do so.
Sertraline has and effect on anxiety and phobic symptoms so if you have these this may be why this was prescribed.
At the end of the day it is up to you what you take and there is no definitive answer to your question as to wheter a certain drug is safe or not safe in breastfeeding. They all have some risks and knowledge is chianging all the time. When a doctor prescribes a drug he has to make and informed judgement and you have to make an informed judgement when deciding whether to take it.
If you feel you need some help from medication for your PNI I would urge you to follow what your doctor prescribes as he/she is the most qualified to judge.
If you really do not trust this prescription, either go back to them ( perhaps go when your own doctor is back) and ask about the possibility of something else maybe the older TCAs or you are entitled to seek a second opinion from another qualified doctor. I would not treat your pharmacist opinion as a second opinion as this advice has its limitations.
I hope this has helped rather than confused you more?
All the best
Veritee